桡动脉入路室间隔缺损封堵术初步临床应用  

Preliminary clinical application of transcatheter closure of ventricular septal defect via radial approach

作　　者：唐文栋[1] 许旭东[1] 白元[1] 沈健[1] 陈峰[1] 朱霓[1] 秦永文[1] 赵仙先[1] 

机构地区：[1]第二军医大学附属长海医院心血管内科,上海200433

出　　处：《介入放射学杂志》2018年第2期114-117,共4页Journal of Interventional Radiology

摘　　要：目的探讨经桡动脉联合股静脉入路行室间隔缺损(VSD)封堵术的可行性和有效性。方法入选2017年6月至11月收治的11例先天性VSD患者(嵴内型3例、膜周部8例,3例伴发膜部瘤),均接受经桡动脉入路VSD封堵术。患者平均年龄(37.82±12.44)岁,平均体重(62.79±14.95)kg,经胸壁超声心动图(TTE)显示平均VSD直径(5.87±1.91)mm。术中通过TTE和左心室造影评价封堵效果。术后24 h,1、3、6个月随访患者心电图、TTE。结果 10例患者成功完成封堵,1例因导丝无法通过缺损而转入外科手术。植入封堵器平均直径(7.50±3.60)mm,平均手术时间(47.20±5.45)min,平均透视时间(13.00±3.65)min,术后平均卧床时间(99.00±11.97)min。2例术中发生桡动脉痉挛。10例患者平均随访(3.50±1.90)个月,均未发生封堵器脱落、残余分流、房室传导阻滞、主动脉瓣返流和桡动脉闭塞等并发症。结论经桡动脉联合股静脉入路VSD封堵术是一种安全有效的治疗方法,值得临床推广应用。Objective To explore the feasibility and efficacy of transcatheter closure of ventricular septal defect（VSD） through radial artery combined femoral vein approach. Methods A total of 11 patients with congenital VSD, who were admitted to authors′ hospital during the period from June 2017 to November2017, were enrolled in this study. The patterns of lesion included intracristal type（n=3） and perimembranous type（n=8）, and in 3 patients the VSD was associated with concant ventricular septal aneurysm. Transcatheter closure of VSD via radial approach was carried out in all patients. The mean age of the patients was（37.82±12.44） years old, and the average body weight was（62.79 ±14.95） kg. The transthoracic echocardiography（TTE） showed that the mean diameter of VSD was（5.87 ±1.91） mm. The effect of transcatheter closure therapy was assessed by intraoperative TTE and left ventriculography. All patients were followed up with electrocardiogram and TTE at 24 hours and one, 3, 6 months after transcatheter closure therapy. Results Successful closure was achieved in 10 patients, and one patient had to be transferred to surgery because the catheter could not pass through the defect. The mean diameter of the implanted occluders was（7.50±3.60） mm, the average procedural time and fluoroscopy time were（47.20±5.45） min and（13.00±3.65） min respectively. The postoperative average in-bed time was（99.00 ±11.97） min. Two patients developed radial artery spasm during the operation. During the follow-up period lasting for a mean of（3.50±1.90） months, no serious complications, such as dropping of occluder, residual shunt, atrioventricular block, aortic regurgitation, radial artery occlusion, etc. occurred in the 10 patients. Conclusion For the treatment of VSD, transcatheter closure through radial artery combined with femoral vein approach is safe and effective.Therefore, this technique is worthy of clinical application.

关 键 词：室间隔缺损 桡动脉 介入治疗 

分 类 号：R528[医药卫生—内科学]